Diaphragmatic hernia medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Antenatal glucocorticoids improve the survival by increasing surfactant secretion. Postnatal medical management is focused on stabilizing the infant before surgical intervention. | |||
==== | ==Medical treatment== | ||
===Antenatal glucocorticoids=== | |||
[[Glucocorticoids|Antenatal glucocorticoids]] improve the survival by increasing the secretion of [[surfactant]] and thus stimulating lung maturation and preventing severe pulmonary hypoplasia.<ref name="pmid24580764">{{cite journal |vauthors=Badillo A, Gingalewski C |title=Congenital diaphragmatic hernia: treatment and outcomes |journal=Semin. Perinatol. |volume=38 |issue=2 |pages=92–6 |year=2014 |pmid=24580764 |doi=10.1053/j.semperi.2013.11.005 |url=}}</ref> | |||
===Preoperative stabilization=== | |||
*Preoperative stabilization of the patient is important as performing the operation in an unstable infant is associated with higher [[morbidity]] and [[mortality]] rates. | |||
*Preoperative stabilization measures include:<ref name="pmid22229104">{{cite journal |vauthors=Kesieme EB, Kesieme CN |title=Congenital diaphragmatic hernia: review of current concept in surgical management |journal=ISRN Surg |volume=2011 |issue= |pages=974041 |year=2011 |pmid=22229104 |pmc=3251163 |doi=10.5402/2011/974041 |url=}}</ref> | |||
**[[Mechanical ventilation]]: The aim is to ensure proper oxygenation without causing any [[barotrauma]] to the lung. Peak inspiratory pressure should be always less than 30 cm H2O | |||
**[[Nasogastric tube|Nasogastric tube insertion]]: The aim is to decompress the [[bowel]] and to give more space for the lung | |||
**[[Blood pressure]] support: using [[vasopressors]] or isotonic fluid: The aim is to keep the [[Mean arterial pressure|mean blood pressure]] above 50 mmHg.<ref name="pmid22229104">{{cite journal |vauthors=Kesieme EB, Kesieme CN |title=Congenital diaphragmatic hernia: review of current concept in surgical management |journal=ISRN Surg |volume=2011 |issue= |pages=974041 |year=2011 |pmid=22229104 |pmc=3251163 |doi=10.5402/2011/974041 |url=}}</ref> | |||
**High-frequency oscillatory ventilation: It is useful in improving the oxygenation without increasing the pressure in the airways or the alveoli. | |||
**[[Extracorporeal membrane oxygenation]]: It is used as the last resort in patients resistant to all the conventional methods of ventilation. | |||
**[[Nitric oxide|Inhaled nitric oxide]]: The [[hypoxemia]] resulting from lung compression can cause hypoxemia that may result in pulmonary vasoconstriction and hypertension. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 19:52, 22 December 2017
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Diaphragmatic hernia Main page |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
Antenatal glucocorticoids improve the survival by increasing surfactant secretion. Postnatal medical management is focused on stabilizing the infant before surgical intervention.
Medical treatment
Antenatal glucocorticoids
Antenatal glucocorticoids improve the survival by increasing the secretion of surfactant and thus stimulating lung maturation and preventing severe pulmonary hypoplasia.[1]
Preoperative stabilization
- Preoperative stabilization of the patient is important as performing the operation in an unstable infant is associated with higher morbidity and mortality rates.
- Preoperative stabilization measures include:[2]
- Mechanical ventilation: The aim is to ensure proper oxygenation without causing any barotrauma to the lung. Peak inspiratory pressure should be always less than 30 cm H2O
- Nasogastric tube insertion: The aim is to decompress the bowel and to give more space for the lung
- Blood pressure support: using vasopressors or isotonic fluid: The aim is to keep the mean blood pressure above 50 mmHg.[2]
- High-frequency oscillatory ventilation: It is useful in improving the oxygenation without increasing the pressure in the airways or the alveoli.
- Extracorporeal membrane oxygenation: It is used as the last resort in patients resistant to all the conventional methods of ventilation.
- Inhaled nitric oxide: The hypoxemia resulting from lung compression can cause hypoxemia that may result in pulmonary vasoconstriction and hypertension.
References
- ↑ Badillo A, Gingalewski C (2014). "Congenital diaphragmatic hernia: treatment and outcomes". Semin. Perinatol. 38 (2): 92–6. doi:10.1053/j.semperi.2013.11.005. PMID 24580764.
- ↑ 2.0 2.1 Kesieme EB, Kesieme CN (2011). "Congenital diaphragmatic hernia: review of current concept in surgical management". ISRN Surg. 2011: 974041. doi:10.5402/2011/974041. PMC 3251163. PMID 22229104.